Provider Demographics
NPI:1801203856
Name:MILLER, MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 MIDDLEWAY PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3909
Mailing Address - Country:US
Mailing Address - Phone:304-376-2603
Mailing Address - Fax:304-229-0666
Practice Address - Street 1:372 MIDDLEWAY PIKE STE A
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428
Practice Address - Country:US
Practice Address - Phone:304-376-2603
Practice Address - Fax:304-229-0666
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.35011223G0001X
WV42921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice